Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort study
Document Type
Article
Publication Date
1-1-2024
Abstract
Background: The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0–38+6 weeks), full term (39+0–40+6 weeks), late term (41+0–41+6 weeks), and post term (≥42+0 weeks) infants. Methods: This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4–6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Findings: Of the study cohort, 0.04 (345/941,221) were neonatal deaths, 0.70 (6627/941,221) were infants with severe neurological morbidity and 4.3 (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95 CI 560.96, 1318.94, p < 0.001); full term (aRRR 1835.77, 95 CI 1279.48, 2633.91, p < 0.001); late term (aRRR 1693.61, 95 CI 859.65, 3336.6, p < 0.001) and post term (aRRR 2231.59, 95 CI 272.23, 18293.07, p < 0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95 CI 118.74, 211.51, p < 0.001); full term (aRRR 112.99, 95 CI 90.56, 140.98, p < 0.001); late term (aRRR 87.94, 95 CI 67.09, 115.27, p < 0.001) and post term (aRRR 52.07, 95 CI 15.17, 178.70, p < 0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2–3 cohort (aRRR 7.36, 95 CI 6.2, 8.74, p < 0.001). Interpretation: A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks’ gestation with the risk greatest in the early term cohort. Funding: National Health and Medical Research Council and Mater Foundation. © 2024 The Authors
Keywords
adult, Apgar score, Article, birth weight, cohort analysis, controlled study, disease association, disease severity, female, gestational age, human, incidence, major clinical study, male, maternal welfare, mortality risk, multiple regression, neurological complication, newborn, newborn disease, newborn mortality, Poisson regression, population research, postmaturity, prematurity, prognosis, Queensland, retrospective study
Divisions
obstetrics
Funders
National Health & Medical Research Council (NHMRC) of Australia,Medical Research Future Fund (MRFF),Mater Foundation,University of Queensland
Publication Title
Lancet Regional Health-Western Pacific
Volume
44
Publisher
Elsevier
Additional Information
Cited by: 0; All Open Access, Gold Open Access